About COVID-19

2019 Coronavirus Disease (COVID-19)

Background: The Centers for Disease Control and Prevention (CDC) is closely monitoring the pandemic caused by a novel coronavirus (COVID-19). The majority of patients have been hospitalized with mild illness, with some progressing to critical illness and death. This is a rapidly evolving situation and updates will be provided as more information becomes available.

Testing: Effective immediately, authorization is no longer required for COVID 19 testing at the IDPH Public Health Laboratories. The testing priorities remain unchanged and can be reviewed on the IDPH COVID webpage, Requesting COVID-19 Testing at IDPH Laboratories.

Note: 1) Testing for other viruses is not required prior to ordering COVID-19 testing via IDPH 2) IDPH or LHD approval is not necessary for COVID-19 testing at commercial, hospital, or academic laboratories.

Fever ( > 100.4 F/38 C) AND new onset respiratory symptom(s) (e.g. cough, or sob, or sore throat) that cannot be attributed to an underlying or previously recognized condition

Residents in congregate care settings that serve vulnerable populations that are part of a cluster in that setting

Fever > 100.0 F/37.8C OR cough OR shortness of breath OR sore throat that cannot be attributed to an underlying or previously recognized condition

Cluster: 2 or more suspect or lab confirmed COVID illnesses occurring among residents within a 7-day period. If suspect cases test negative for COVID-19 and either have an alternative diagnosis or do not have progressive respiratory illness, they are no longer considered to have suspect COVID-19 illness.

1 Congregate setting that serves vulnerable populations: e.g. a skilled nursing facility, an assisted living facility, group home, homeless shelter, or correctional setting. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus species, such as coronavirus HKU1, NL63, OC43, or 229E.

Treatment:

No vaccine or specific treatment for COVID-19 infection is available at this time. At present, medical care for patients with COVID-19 is supportive. For updates, see CDC's Interim Clinical Management Guidance.

COVID-19 Lab Testing Information

Improved testing capacity allows for improved ability to identify COVID-19 cases; prompt reporting to public health is fundamental for investigation and isolation of cases to mitigate spread.

Providers are encouraged to obtain specimens for COVID-19 molecular testing for all patients seeking care who are symptomatic, even those with mild symptoms.

All providers and testing sites must report to Public Health all individuals tested for COVID-19, in accordance with the Illinois Control of Communicable Diseases Code (77 Ill. Adm. Code 690.200(a)(5)).

All health care providers that are unable to establish an electronic laboratory reporting feed to INEDSS shall use another electronic mechanism to submit such data, which may include a Health Level Seven (HL7) electronic data feed or submit through an established REDCap electronic case submission form. These submissions shall be completed within 24 hours of ordering a COVID-19 laboratory test, and within 24 hours of a laboratory result. To establish an HL7 feed, please reach out for assistance at: CDPHCovidDataHub@rush.edu. A REDCap case report form can be submitted at: https://redcap.dph.illinois.gov/surveys/?s=FR7MAJAY84.

Additionally, entities that are not reporting through I-NEDSS need to notify CDPH via email of the location of testing and type of test offered at: covid19pui@cityofchicago.org.

Laboratory capacity to diagnose COVID-19 infections has increased to support testing for many patients in outpatient settings who have symptoms suggestive of COVID-19.

When testing resource limitations necessitate prioritization of testing decisions, providers should refer to CDC PRIORITIES FOR COVID-19 TESTING for molecular testing, which are summarized below. However, when adequate testing capacity is available, all symptomatic patients should be tested.

High Priority:

Hospitalized patients

Healthcare facility workers, workers in congregate living settings, and first responders with symptoms

Residents in long-term care facilities or other congregate living settings, including prisons and shelters, with symptoms

Persons identified through public health cluster and selected contact investigations

Persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans.

Testing individuals without symptoms is not a priority in routine clinical settings

Testing of other individuals, including asymptomatic individuals identified in health care settings, congregate living settings, and workplaces may occur in limited settings as part of public health investigations and infection control interventions.

Specimen collection should be performed in a normal examination room with the door closed.

HCP in the room may wear a facemask, eye protection, gloves, and a gown.

N95 respirators should be prioritized for other procedures at higher risk for producing infectious aerosols (e.g., intubation), instead of for collecting nasopharyngeal swabs.

The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.

Outpatient EnvironmentalInfection Control Tips

Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings.

Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.

Clean and disinfect procedure room surfaces promptly after diagnostic respiratory specimens obtained. In general, only essential personnel should enter the room of patients with suspected or confirmed COVID-19.

Although spread of SARS-CoV-2 is believed to be primarily via respiratory droplets, the contribution of small respirable particles to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely.

The amount of time that the air inside an examination room remains potentially infectious is not known and may depend on a number of factors including the size of the room, the number of air changes per hour, how long the patient was in the room, if the patient was coughing or sneezing, and if an aerosol-generating procedure was performed. Facilities will need to consider these factors when deciding when the vacated room can be entered by someone who is not wearing PPE.

For a patient who was not coughing or sneezing, did not undergo an aerosol-generating procedure, and occupied the room for a short period of time (e.g., a few minutes), any risk to HCP and subsequent patients likely dissipates over a matter of minutes. However, for a patient who was coughing and remained in the room for a longer period of time or underwent an aerosol-generating procedure, the risk period is likely longer.

For these higher risk scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the airborne route (e.g., measles, tuberculosis) and to restrict HCP and patients without PPE from entering the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.

HCP already in PPE or Environmental Services (EVS) personnel may enter the room after sufficient time has elapsed, depending on the use of the room as above, and should wear a gown and gloves when performing terminal cleaning. HCP/EVS personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient.

A facemask (if not already wearing for source control) and eye protection should be added if splashes or sprays during cleaning and disinfection activities are anticipated or otherwise required based on the selected cleaning products. Shoe covers are not recommended at this time for personnel caring for patients with COVID-19.

Considerations for Protecting and Managing Healthcare Personnel (HCP)

Many facilities have already experienced staffing shortages due to HCP exposures, illness, or need to care for family members at home. Plans and processes to mitigate staffing shortages can always be improved and current recommendations are described below.

Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.

As part of routine practice, HCP should be asked to regularly monitor themselves for fever and symptoms of COVID-19.

HCP should be reminded to stay home when they are ill.

Screen all HCP at the beginning of their shift for fever and symptoms consistent with COVID-19*

Actively take their temperature and document absence of symptoms consistent with COVID-19*. If they are ill, have them keep their cloth face covering or facemask on and leave the workplace.

*Fever is either measured temperature >100.0°F or subjective fever. Note that fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs). Clinical judgement should be used to guide testing of individuals in such situations. Respiratory symptoms consistent with COVID-19 are cough, shortness of breath, and sore throat. Medical evaluation may be warranted for lower temperatures (<100.0°F) or other symptoms (e.g., muscle aches, nausea, vomiting, diarrhea, abdominal pain headache, runny nose, fatigue) based on assessment by occupational health.

If HCP develop fever (T≥100.0°F) or symptoms consistent with COVID-19* while at work they should keep their cloth face covering or facemask on, inform their supervisor, and leave the workplace.

Healthcare facilities should consider foregoing contact tracing in favor of universal source control for HCP and screening for fever and symptoms before every shift.

before every shift.

Return to Work Criteria for HCP with Confirmed or Suspected COVID-19

As of April 30, 2020, CDC recommends new criteria for return to work for HCP with confirmed or suspected COVID-19 which include a symptom-based (i.e., time-since-illness-onset and time-since-recovery strategy), time-based strategy or a test-based strategy. Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture. Detecting viral RNA via PCR does not necessarily mean that infectious virus is present.

Symptomatic HCP with suspected or confirmed COVID-19:

Symptom-based strategy. Exclude from work until:

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

At least 10 days have passed since symptoms first appeared

Test-based strategy. Exclude from work until:

Resolution of fever without the use of fever-reducing medications and

Improvement in respiratory symptoms (e.g., cough, shortness of breath), and

Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens). Of note, there have been reports of prolonged detection of RNA without direct correlation to viral culture.

HCP with laboratory-confirmed COVID-19 who have not had any symptoms:

Time-based strategy. Exclude from work until:

10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used.

Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.

Test-based strategy. Exclude from work until:

Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).

Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.

Consider consulting with local infectious disease experts when making decisions about discontinuing Transmission-Based Precautions for individuals who might remain infectious longer than 10 days (e.g., severely immunocompromised).

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HOW TO REPORT COVID-19

HOW TO REPORT COVID-19 TO CDPH

Both individual lab-confirmed cases and clusters are reportable conditions.

Providers must report all positive cases into INEDSS.

If you are an outpatient facility and do not have access to INEDSS or you need to report a cluster of 2 or more cases (at least one of which is lab-confirmed) in a congregate setting (such as a long-term care facility, childcare setting, correctional facility, etc), please complete the COVID-19 Online Case Report Form (a confidential online survey powered by IDPH REDCap).

***Concerning calls to 311 for COVID-19, 311 calls should be reserved for discussion of management of confirmed COVID-19 cases only or urgent matters related to disposition of PUIs or cases. For these issues, call 311 during business hours / after hours / weekends / holidays and ask to speak with the medical director on call (312-744-5000 if outside the City of Chicago).

During early phases of the COVID-19 response, with limited laboratory capacity, COVID-19 testing was prioritized to optimize care of hospitalized patients, identify those at highest risk of complications from infection, and detect cases in critical infrastructure workers and first responders. Laboratory capacity to diagnose COVID-19 infections has increased to support testing for many in outpatient settings who have symptoms suggestive of COVID-19. Increasing the ability to identify COVID-19 cases and report to public health is fundamental forinvestigation and isolation of cases to mitigate spread.

Providers are encouraged to obtain specimens for COVID-19 molecular testing for all patients seeking care who are symptomatic, even those with mild symptoms.

A list of commercial and hospital-based laboratories may be foundhere.

Checklists for Healthcare

HAN Registration Request

Access Request Form

Important! Please read the instructions very carefully.Note: Fields with asterisks * are required fields that you must fill out to complete the request.

Introduction

User Information

Membership Type

Subscriptions and Dynamic Groups

Verification

The Chicago HAN is the Chicago Department of Public Health (CDPH)'s primary method of sharing information about urgent and emerging public health situations with Chicago clinicians, laboratories and partner agencies.

You can choose to receive alerts and see generally available information or choose to be a full member and have access to more detailed information about outbreaks and other topics as well as be granted use of a HIPAA Compliant inbox to exchange protected health information.

Click "Start" below to begin the process.

FAQs for on specimen submission

Frequently asked questions on specimen submission:

Acceptable Media Types:

The U.S. Food and Drug Administration recently released additional media types that may be used as alternatives for universal transport media (UTM) or viral transport media (VTM), due to a nationwide shortage. A list of acceptable media types can be found in this FAQ here under “What If I Do Not 2 Have….?”. The Division of Laboratories will continue to send collection and transport supplies for COVID-19 testing performed at IDPH Labs to providers on a limited basis due to this nationwide shortage. The Supply Request form can be found here.

For the most up-to-date information on responses to COVID-19 for the Substance Use Disorder Treatment field, go to https://www.samhsa.gov/

Additional Information on Testing

SARS-CoV-2 antibody tests are available but currently not approved by the Food and Drug Adminstration.

Sensitivity, specificity, and reliability of available antibody tests has not yet been determined, and as such, PCR testing is recommended in conjunction with antibody testing in order to diagnose or exclude SARS-CoV-2 infection.

False positives antibody tests might occur in the presence of past or present infection with other coronaviruses such as HKU1, NL63, OC43, or 229E.

Although serologic testing by itself should not be used to diagnose infection with SARS-CoV-2, any positive IgM or IgG results should be reported to public health via the Illinois National Electronic Disease Survellance System (I-NEDSS). For providers not able to report via I-NEDSS, results may be reported through the COVID-19 Online Case Report Form (confidential online survey powered by REDCap).